The process of seeking input on challenging cases is an important element of the diagnostic process within an Anatomic Pathology (AP) department. Intradepartmental consultations play a key quality assurance role in the AP laboratory—they help to maximize the value of the complex and vital clinical information that AP provides to patient care, as well as being a crucial component of pathology training. In fact, performance of a high number of intradepartmental consultations has been used as a differentiator in pathology laboratories' marketing materials. A pathologist may seek consultation from colleagues while evaluating a difficult pathology result, when a patient's clinical history suggests closer scrutiny, or in other situations specified by departmental policies. The results of these intradepartmental consultations are an important part of the case documentation, contributing to the published results while remaining separate from them.
An increasingly valuable tool to the AP laboratory and intradepartmental consultations are physical case materials, such as slides and blocks of human tissue, for example, that are created for diagnostic evaluation of a case. Particularly for difficult or complex cases, these materials may be referred to again and again as the case evolves and as new testing methodologies become available.
An AP department must balance the competing priorities of seeking additional input on a case with the timely dissemination of results when managing and documenting intradepartmental consultations. Both information and physical case materials must be efficiently managed to maximize the value of the consultation process. The dynamic and collaborative nature of the consultation process, coupled with the time-sensitive nature of pathology results, make the consultation process a challenge for information systems to fully support.
A typical intradepartmental process flow can be described as follows. A pathologist determines that a consultation is desired, prepares a routing slip with the list of proposed consultants and collects the case materials relevant to the consultation, which are delivered to the first consultant on the routing. Each consultant in turn reviews the case materials and notes an opinion, and the consult materials are then delivered to the next consultant on the routing. Following the completion of the routing, the original pathologist documents a summary of the consultation in the case report and issues a final report.
This process is limited in a number of ways. For example, the sequential nature of the process requires manual “handoffs” to keep the consultation moving between consultants. There is no mechanism for determining the status of a consultation or location of the physical case materials during the process and no ability to easily re-route a consultation to take advantage of other consultants' availability. In addition, there is no way to secure the information generated from the consultation during the process. Further, electronic access to consultation information is limited to that which may be entered on-line after the process is completed.
Another notable limitation of the typical process described above is that the determination of when to seek a consultation is left solely to the user. However, many departments may wish to identify situations where consultation should be routinely sought, based on standard criteria such as the type of case being diagnosed or the nature of the findings, such as a first-time malignant diagnosis. Also, departments may wish to institute additional levels of diagnostic review to take advantage of specialists (for example, all prostate biopsies are reviewed by the departmental genitourinary specialist), or as part of a quality initiative where all diagnoses of a certain type are reviewed. Under the typical process, it is also difficult to ensure compliance with existing departmental policies and to make use of the data generated by the process to further quality initiatives.
Accordingly, a system and method that provides a complete, end-to-end solution for initiating, managing, and documenting intradepartmental consultations is desirable. Additionally, a system and method for tracking physical case materials in conjunction with the consultations would be advantageous.